Provider Demographics
NPI:1346209921
Name:COTTLES, CHERILYNNE TONI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERILYNNE
Middle Name:TONI
Last Name:COTTLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7422
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-0422
Mailing Address - Country:US
Mailing Address - Phone:504-259-4541
Mailing Address - Fax:318-356-9546
Practice Address - Street 1:1640 BREAZEALE SPRINGS ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4278
Practice Address - Country:US
Practice Address - Phone:318-352-9299
Practice Address - Fax:318-356-9546
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.016920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1321117Medicaid
LAB89188Medicare UPIN
LA1321117Medicaid